Provider Demographics
NPI:1326536475
Name:MCCOY, PEGGY SHAWN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:SHAWN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-0541
Mailing Address - Country:US
Mailing Address - Phone:662-751-4800
Mailing Address - Fax:662-751-4987
Practice Address - Street 1:2225 HALEY BARBOUR PKWY
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-4796
Practice Address - Country:US
Practice Address - Phone:662-751-4800
Practice Address - Fax:662-751-4987
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR718386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily